Lisa Malak, AGNP-C

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ00963300 Issued in NJ

Practice address

106 Bridge Ave Ste 6
Bay Head, NJ 08742-5073

Phone

(732) 996-6935

NPI assigned

Sep 19, 2019

Last updated

May 9, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1093365199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EARL DR",
            "city": "BRICK",
            "state": "NJ",
            "postal_code": "087236470",
            "telephone_number": "732-996-6935"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 BRIDGE AVE STE 6",
            "city": "BAY HEAD",
            "state": "NJ",
            "postal_code": "087425073",
            "telephone_number": "732-996-6935"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALAK",
        "first_name": "LISA",
        "credential": "AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-19",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NJ",
            "license": "26NJ00963300",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00963300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Timothy Fitzgerald, LSW, LCSW
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• CHI P Nguyen, L.AC, C.A.
• Lynn O'Hara, MS, RD, LPC
• Abigail Porch, RD
• Chandler Patricia Ray, RDN

• Gerontology Nurse Practitioner in Bay Head, NJ
• Providers in Bay Head, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.